Final Exam 162

Postpartum blues vs. postpartum depression:

-Postpartum Blues: Symptoms disappear without medical intervention. Occurs within the first 2 weeks of postpartum.Able to safely care for self and baby.50-70% -Postpartum Depression: Requires psychiatric (10-15%) interventions. Occurs within the first 12 months postpartum. Unable to safely care for self and/or baby.

What 3 structures close in fetal cardiac circulation?

-THE FORAMEN OVALE: During fetal development this small flap-like opening is normally present in the wall between the right and left upper chambers of the heart (atria), and closes w/in 30 months. Foramen ovale closure is a function of changing atrial pressures. -THE DUCTUS ARTERIOSUS: Initial elevation of the systemic vascular pressure changes aorta bloodflow from the fetal ductus arteriosus, now going to the pulmonary artery. Closed by 4 weeks. -THE DUCTUS VENOSUS: closure related to mechanical pressure changes after severing of the cord, redistribution of blood, and cardiac output. Closure forces perfusion of the liver. Closes by 2 months.

Newborn skin assessment:

Color (acrocyanosis, pink, jaundice?), Erythema neonatorum (newborn rash), lanugo (hair), milia (exposed sebacious glands), mottling, mongolian blue spots(birthmark), vernix caseosa, telangiectatic nevi (stork bites- birthmark),

Involution terms

-Involution: rapid reduction in size and returning of the uterus to its pre-pregnant state (good) -Subinvolution: failure of the uterus to return to the normal size

General teaching for all STD's:

-Don't have sex during an outbreak of lesions ESPECIALLY IF PREGNANT. Don't do that to your baby... -Use safer sex practices -Have partner tested and if necessary treated -Come to the Dr. at the FIRST sign. Don't wait.

On to Post-op! Pain control post-op:

-Drug therapy: Analgesics (use w/ caution so they don't mask possible sx of anesthesia reaction). Opioid analgesics given in 1st 24-48hrs to control acute pain, PCA(patient controlled analgesics) 48hr+ is good option. -Common meds: morphine (Statex), hydromorphone (Dilaudid), ketorolac (Toradol), codeine, butorphanol *(Stadol)*, oxycodone w/ aspirin (Percodan) or oxycodone w/ acetaminophen (Percocet) -Other techniques: positioning, massage, relaxation techniques, and diversion.

Erythromycin ophthalmic:

-Erythromycin ophthalmic (0.5%) for prophylactic eye treatment (prevents BOTH chlamydia/gonorrhea opthalmia neonatorum AND eye infections related to other bacteria that the infant picks up as it goes through the birth canal). Given 1-2 hrs after birth.

Meds for baby at birth?

-Erythromycin ophthalmic (0.5%) for prophylactic eye treatment (prevents BOTH chlamydia/gonorrhea opthalmia neonatorum AND eye infections related to other bacteria that the infant picks up as it goes through the birth canal). Given 1-2 hrs after birth. -Vit K (injection in vastus lateralis) to prevent bleeding. Administer 1 hr after birth -Prophylactic hepatitis treatment (antibiotic) to treat HBV (Hepatitis B Virus). 3 part injection series to vastus lateralis done at birth, 1 month, and 3 months.

How is Condylomata Acuminata (aka genital warts) transmitted? Treatment of choice?

Condylomata Acuminata (aka genital warts) is type 6 and 11 of low-risk Human Papilloma Virus (HPV) that is transmitted by sexual contact. Treatment involves removing the warts as well as podofilox (Condylox) cream 2x daily for 3 days and no treatment for next 4 days, then that cycle repeated for 4 cycles. There isn't a cure, and recurrences after treatment are likely. Another tx is imiquimod cream to boost immune system and sinecatechins ointment (made from green tea extract). Yet another therapy is cryo-therapy every 1-2 wks until warts resolve.

On to Medications! Hepatitis B:

HBV (Hepatitis B Virus). 3 part injection series to vastus lateralis done at birth, 1 month, and 3 months.

HPV genital warts nursing interventions:

HPV can, if left untreated, lead to cervical cancer, however genital warts is a lower-risk strain of HPV. Teach about preventative HPV vaccines such as Gardasil or Cervarix to prevent HPV infection and cervical cancer. Gardasil is best bc it prevents 4 strains while Cervarix only prevents 2. Should be given before first sexual activity. The presence of warts should increase suspicion that pt had exposure to other STD's. Teach that OTC wart treatments should not be used.

How is Herpes transmitted? Treatment of choice?

Herpes simplex virus (HSV) is an acute, recurring, incurable viral disease transmitted by sexual contact including kissing. It's the most common STI in the United States. Treatment of choice is antiviral drugs esp. *Acyclovir (Zovirax). Doesn't cure disease, only decreases severity + frequency and promotes healing.

Compare caput succedaneum vs cephalohematoma:

CAPUT SUCCEDANEUM-a localized, easily identifiable soft area of fluid under the scalp generally resulting from a long and difficult labor or vacuum extraction. Caused by sustained pressure of presenting part against cervix resulting in compression of local blood vessels and slowed venous return, causing edematous swelling. *Crosses suture lines*, bc it's above periosteal membrane. Reabsorbed 12hrs-a few days. CEPHALOHEMATOMA-a collection of blood between the surface of a cranial bone and periosteal membrane. Disappears 2wks-3mo. If large, can lead to anemia and hotn. Scalp feels loose and slightly edematous. *Doesn't cross suture lines* bc dura mater attaches to skull at suture lines blocking it from doing so. BELOW periosteum.

Post-op assessment and what's normal/abnormal:

Cardiac: Vital signs & heart sounds are assessed every 15 min until pt's condition is stable. BP 25% higher than pre-surgery is abnormal (a 15-20 point difference), pulses should be equal, assess legs for redness, pain, warmth and swelling which could indicate DVT, hematoma Respiratory: airway & gas exchange, respiratory depression (abnormal) GI: nausea and vomiting, constipation GU: control of urination. urine retention is common, but requires intervention. Neuro: level of consciousness, motor and sensory function, pain

Meconium aspiration

Caused by fetal distress in utero. Can lead to pneumonia in newborn and/or respiratory issues. Only specifically trained personnel can suction if aspirated. *If meconium is present, prepare for C-Section* meconium=c-section

What is the treatment of choice for Gonorrhea?

Ceftriaxone (Rocephin) 250mg in a single dose IM injection (Other drugs have become resistant) PLUS azithromycin (Zithromax) 1g orally OR doxycycline 100mg orally for 7 days to treat co-infection w/ Chlamydia unless (-)chlamydia result has been obtained

How is Chlamydia trachomatis transmitted? Treatment of choice? Risk factors?

Chlamydia is a bacterial infection transmitted by sexual contact. Treatment of choice is azythromycin, (Zithromax) 1g single oral dose. (Alt. Doxycycline orally twice daily for 7 days). Risk factors: . African-american women age 15-24 @ highest risk. *All sexually active women 24 yrs and younger and women older than 25 w/ new or multiple partners should be screened regularly.* Also, new or multiple sexual partners, age younger than 26 and female, or a male having sex with a male.

What is a boggy uterus, uterine atony and why is that a problem?

A boggy uterus (above the umbilicus and feels soft and spongy rather than firm and well contracted) is associated with excessive uterine bleeding. As blood collects and forms clots w/in the uterus, the fundus rises; firm contractions of the uterus are interrupted, causing a boggy uterus aka uterine atony (relaxation).

Cyclophasphamide:

A cytotoxic anti-cancer drug indicated for Hodgkin's disease, non-Hodgkin's lymphomas, multiple myeloma, and solid tumors of the head, neck, ovary, and breast.

Oxytocin:

A medication used after childbirth to increase uterine contractions.(To prevent atony) Can prevent PP hemorr.

Stadol:

A post-op analgesic for pain relief. 1-2mg Q 3-4 hrs

Describe LGA- Large for Gestational Age

Above 90th percentile of weight. Usually caused by gestational diabetes, prolonged pregnancy, multiparity, and complications. Does not have lanugo or vernix caseosa. Assessment findings & complications: shoulder trauma from birth, hyperbilirubinemia, hypoglycemia, polycythemia(high Hct), poor feeding behavior, C-section.

Cytotec:

Aka Misoprostol administered vaginally for induction of abortion in 1st and 2nd trimesters. Acts on uterus to promote ripening and contractions to induce labor. *Can also stop postpartum hemorrhage.*

Methergine:

Alternate to oxytocin and (Cytotec) to promote uterine contractions. Not as safe bc risk of severe hypertension.

Methotrexate:

Anti-cancer drug that works by inhibiting the S-phase of DNA synthesis. Used with leucovorin to save regular cells, but dosing is critical. Like, life or death. Curative for choriocarcinoma. Also used for non-Hodgkin's lymphoma & acute lymphocytic leukemia of childhood.

Cisplatin:

Anti-cancer drug used to kill cells in metastatic testicular and ovarian cancers and advanced bladder cancer. (Unlabeled use for lung, head & neck cancers.)

On to Newborn! *ID and apply the Apgar system of scoring as an eval of the newborn's adaptation.

Apgar scoring system is used to evaluate the physical condition of the newborn at birth. Performed once 1 min after birth, then again at 5 min's, & receives a total score (0-2 per category). If that score is less than 7, the test is repeated again every 5 min's, up to 20 min's after birth. 1.)The HEARTRATE is auscultated at the junction of the umbilical cord and skin- MOST IMPORTANT ASSESSMENT. If heartrate is less that 100 bpm, infant needs immediate resuscitation. 0=absent, 1=slow/ less than 100bpm, 2=greater than 100bpm 2.) RESPIRATION effort is 2nd most important. Vigorous cry=adequate respirations. 0=absence/apnea. 1=slow/irregular, 2=good breathing w/ crying (30-60) 3.)MUSCLE TONE determined by degree of flexion (bending) & resistance to straightening the extremities. 0=flaccid/limp, 1=some flexion of extremities, 2=active movement of extremities 4.) REFLEX RESPONSE/irritability is evaluated by stroking the baby's back along the spine or flicking soles of feet. 0=absent, 1=grimace; noticeable facial movement, 2=vigorous cry, coughs, sneezes, pulls away when touched 5.) SKIN COLOR inspected for cyanosis and pallor. Generally newborns have pink body with blue extremities (aka acrocyanosis- 85% of all normal babies) 1 min after birth. 0=pale or blue, 1=pink body, blue extremities, 2= pink body *and* extremities. Scores: 7-10 indicates newborn in good condition who requires only nasopharyngeal suctioning and perhaps some O2 near face. 4-7 suggests need for stimulation. Less than 4 may require resuscitative measures. Scores less than 3 @5 min may correlate w/ neonatal mortality.

Nubain:

At low doses, Nubain is an analgesic equal to morphine, but maximal pain relief is lower than morphine. 10mg Q 3-6 hrs.

Reflexes:

Baby reflexes indicating intact CNS: -Startle or moro: elicited when newborn is startled by a loud noise, or lifted slightly above the crib and suddenly lowered. In response, the newborn straightens arms +hands outward while knees flex. Slowly arms return to chest, like a hug, fingers spread forming a C w/ index & thumb, and newborn may cry. -Tonic neck or fencing: elicited when the newborn is supine w/ head turned by nurse to one side. In response the extremities on the same side straighten, where on the opposite side they flex. -Galant or trunk incurbation: assesses for brain damage by placing the newborn on their stomach, suspended, and lightly stroke one side of the spine. Baby should laterally flex toward the stimulated side. -Grasp: placing your finger or another object in the palm of newborn's hand or stroking the palm resulting in newborn closing fingers in a grasp.

Describe SGA- Small for Gestational Age

Below 10th percentile of weight. Normal assessments include large head, thin arms&legs, loose, dry skin w/ no fat. Could be caused by mother being a substance abuser, hptn, age, level of prenatal care, live in high altitude. Or fetal- TORCH infections, cord anomalies, genetics, placental factors. Complications for an SGA baby: fetal hypoxia, hypoglycemia, hypothermia, polycythemia, and aspiration syndrome.

How is HPV genital warts diagnosed?

By examination of the lesions Pap smear and HPV DNA testing screens for HPV.

How is Herpes diagnosed?

Diagnosed with a viral cell culture or polymerase chain reaction(PCR) assays of lesions (PCR is best, but most expensive). Lesion fluid obtained within 48 hours of appearance of first outbreak will yield most accurate results. Can be either type 1(cold sores) or type 2(BAD!)

Syphilis nursing interventions:

Discuss safer sex practices such as use of latex or polyurethane condoms for genital, anal and oral sex, wearing gloves for finger or hand contact with the vagina or anus, abstinence, mutual monogomy, and decreasing number of sexual partners. Discuss how important early treatment is.

What is nursing care of a Herpes infected patient?

First, assess pt and partners emotional response. Shock is usually the initial reaction. Validate, etc. Then teach about medical tx, recurrent episodes and triggers, side fx, frank discussion of sexual activity including abstaining from sexual activity during outbreaks to avoid pain and transmission to partner. Avoid unprotected sex with infected partner while pregnant.

Which (of the 5) STD's are only treatable w/ no cure?

Genital warts aka condylomata acuminata (type of HPV), and Herpes

Geriatric and pediatric surgical pt. differences: SEE AGAIN>>>>>

Geriatric: Patient's circulatory system is slower and therefore meds react differently and can absorb slower, making pt at risk to accumulate too much of pain med before it's processed by the body. Older pt.'s are at risk for hypothermia, high pulse could indicate shock, hemorrhage, or pain Pediatric: patient's are more sensitive to meds and smaller doses need to be delivered. Cannot maintain body temp as well,

How is Gonorrhea transmitted?

Gonorhhea is a bacterial infection transmitted by direct sexual contact with mucosal surfaces. (oral anal vaginal)

Which STD's are known for changes in vaginal and penile discharge?

Gonorrhea and Chlamydia

Level of fundus after delivery:

Immediately after delivery of the placenta, the top of the fundus (top portion of uterus) is in the midline and approximately halfway between the symphysis pubis (the midline cartilaginous joint @ bottom front of pelvis) and the umbilicus. W/in 6-12 hrs after birth the fundus rises to the level of the umbilicus (belly button). The height of the fundus then decreases about one fingerbreadth (1cm) each day.

Rhogam:

In mothers who are RH-, their body makes antibodies that destroy the RHD factor in RH+ blood. If your baby has RH+ blood, the antibodies can cross the placenta destroying the baby's red blood cells. (Only for RH- mothers with RH+ babies, NOT vice versa.) Rhogam is a vaccine that prevents the mother from making her own antibodies to the RH D factor of RH+ blood. Given w/in 72 hrs after first birth as an injection.

What are the symptoms of HPV genital warts?

Initially sx are small, white, or flesh-colored papillary lesions that may grow into larger cauliflower-like masses. Can be on external or internal surfaces of genitalia including mucosal surfaces of vagina + urethra

What are some newborn symptoms of hypoglycemia?

Jitteriness, tremors, high/weak cry,lethargy, irritability, hypotonia, poor feeding/suck, pale, cyanotic

Vincristine:

M-phase cell-division-inhibiting anti-cancer drug that's bone marrow sparing & therefore good for combo chemotherapy. Used for Hodgkin's and nonHodgkin's lymphomas, acute lymphocytic leukamia, (some sarcomas), breast cancer, and bladder cancer.

What are the symptoms of Chlamydia trachomatis?

Men: urethritis (main sx in men) which causes dysuria, frequent urination and mucoid discharge (more watery and less copious than gonorrheal discharge) Women: vaginal or urethral discharge, dysuria (painful urination), pelvic pain, irregular bleeding.

Risk factors for herpes?

Multiple sexual partners, male having sex with a male, those HIV positive, having herpes positive partner(s), most common in African-American women. *Many people don't know they have herpes bc no sx or diag.*

Normal weight at birth and vital signs?

O2: 95+ P:110-160 BP: 70-50/45-30 T: 97.7-99.4 R: 30-60/min Blood Glucose: >40 Average normal weight: 7 1/2lbs. Weight loss in 3-5 days (5-10%) and regain in 10 days.

Fentanyl:

Opioid pain relief drug that has a fast onset and short duration of action. Most commonly used IV opioid when rapid analgesia is desired. Recommended opioid for pt's with end-organ failure. 0.1mg

What is jaundice in the newborn and why do we check for hypoglycemia? Physiologic (normal cause) and pathologic (disease-related cause)

Physiologic jaundice occurs after the first 24 hours of life and is a normal biologic response of the newborn. Main reasons for jaundice (in general) are: increased amounts of bilirubin delivered to the liver, defective hepatic uptake of bilirubin from the plasma, defective conjugation of bilirubin, defect in bilirubin secretion, and increased reabsorption of bilirubin from the intestine. Pathologic jaundice occurs before 24 hrs and indicates a problem (metabolism and liver function). Breast feeding jaundice is related to inadequate fluid intake and dehydration, and breastmilk jaundice is related to components in breast milk interfering with bilirubin metabolism. It's important to check for hypoglycemia because glucose is the newborn's main source of energy in the 1st 4-6 hrs, so glucose <40 can result in coma or death

SIDS

SIDS (sudden infant death syndrome). Place NOTHING in crib where baby sleeps. Place baby on his/her BACK TO SLEEP. Correlated w/ low apgar scores.

How is Chlamydia trachomatis diagnosed?

Sampling of cells from the endocervix, urethra or both w/ swab. Since it can only produce inside cells, cervical host cells are required for the swab.Then tissue culture. Urine sampling is also a new acceptable method.

System changes after delivery (e.g. GI/GU)

Slowed peristalsis a little bit, may be constipated for first few days after birth.

How is gonorrhea diagnosed?

Swab of male urethra or female cervix, then molecular testing is done through Nucleic Acid Amplification Tests. Also, men can be diagnosed w/ a gram stain smear of urethral discharge for gram negative diplococci.Can't be done for women, bc the female genital tract naturally harbors other neisseria strains resembling gonorrhea.

What are the symptoms of Herpes?

Sx include prodrome, which is an itching or tingling sensation 1-2 days before an outbreak. The outbreak, which is a cluster of vesicles (blisters) on the site of innoculation (e.g. perianal region) that rupture spontaneously in 1-2 days and leave ulcerations that become painful, then resolve in 2-6 weeks. Cold-like sx. External dysuria. Remains dormant, then recurs when triggered eg. immune system is lowered.

What are the symptoms of Gonorrhea?

Symptoms appearing 3-10 days after contact are: Men: dysuria, penile discharge either profuse, yellowish green fluid or scant clear fluid. Infection sites most common in urethra, and possibly prostate, seminal vesicles, and epididymis. Women: change in vaginal discharge (yellow, green, profuse, odorous) urinary frequency, or dysuria. Most common infection sites in cervix and urethra. Anal manifestations: itching, irritation, rectal bleeding or diarrhea, painful defecation. Mouth: reddened throat, ulcerated lips, tender gingivae, and lesions in the throat.

What are the symptoms of Syphilis?

Symptoms can occur in 4 stages: Stage 1: Primary syphilis. Appearance of ulcer (chancre) at site of entry (all "sexual areas", and hands). W/in 3-7 days the small papule breaks down into typical appearance: smooth, painless indurated weeping lesion Stage 2: Secondary syphilis. Now systemic. Flu-like sx. Rash appears on palms and soles and mucous membranes. Patchy alopecia on head and face (eyebrows). Stage 3: Latent syphilis. Can be early latent(recurrence of lesions during 1st year after initial infection) or late latent(recurrence after 1 year after initial infection. Not contagious except to fetus of pregnant woman. VDRL may not show positive result in this phase. Stage 4: Tertiary syphilis- recurrence after 4-20 years, only in untreated cases. Can mimic other conditions bc ANY organ system can be affected (neurological, cardiovascular,) and has benign lesions on skin, mucous membranes and bones.

How is Syphilis (Treponema pallidum) transmitted? Treatment of choice?

Syphilis is a bacterial infection aka Treponema pallidum transmitted by sex, blood, or close body contact eg. kissing. Treatment of choice is Benzathine penicillin G given IM in single 2.4 million-unit dose for all 4 stages and is good unless pt is pregnant or HIV infected. Even if pt is penicillin resistant, pt should still be given treatment. Pt should be desensitized to penicillin and monitored for 30 minutes.

Which (of the 5)STD's are curable?

Syphilis, gonorrhea, and chlamydia

How is Syphilis diagnosed?

T. pallidum can only be *seen* with a darkfield microscope, but serologic tests screen for it's antibody. VDRL blood serum tests.

Nursing interventions for gonorrhea?

Teach that: *all patients with gonorrhea should be tested for syphilis, chlamydia, hepatitis B and C, and HIV infection, and if possible, examined for HSV and HPV, bc they may have been exposed to these STD's as well.*

On to Postpartum! Define 3rd stage and 4th stage and postpartum:

The 3rd stage begins once your baby is born, and ends when you deliver the placenta. The 4th stage is birth to 1 hour after birth(puerperium) Postpartum is the period after childbirth lasting 6 wks

Care of episiotomy

The edges should be drawn together. Initial healing takes 2-3 weeks, but full healing takes 4-6 months. Assess using REEDA scale: Redness, Edema, Ecchymosis (bruising), Drainage, Approximation. Keep it clean, don't douche, sitz baths could help a couple times a day, loose clothing (good for hemorrhoids too)

Lochia:

Vaginal discharge after birth. Red/rubra(1st-3rd day), pinky-brown/serosa(4th-10th day), white/alba(10th-14th day).

Phytonadione:

Vitamin K! The only form of vitamin K available for therapeutic use. Used for newborns as an injection to prevent hemorrhage.

What is dissociative anesthesia?

a form of anesthesia characterized by catalepsy, catatonia, analgesia, and *amnesia*. It does not necessarily involve loss of consciousness and thus does not always imply a state of general anesthesia

A 29 year old female is diagnosed with Chlamydia during a routine pelvic examination. The nurse knows that teaching regarding the management of the condition has been effective when the patient states which of the following? a.) "My partner will need to take antibiotics at the same time I do." b.) "Go ahead and give me the antibiotic injection, so I will be cured." c.) "I will use condoms during sex until I finish taking all the antibiotics." d.) "I do not plan on having children, so treating the infection is not important."

a.) "My partner will need to take antibiotics at the same time I do."

Which infection, reported in the health history of a woman who is having difficulty conceiving, will the nurse ID as a risk factor for infertility? a.) N. gonorrhoeae b.) Treponema pallidum c.) Condyloma acuminatum d.) Herpes simplex virus type 2

a.) *N. gonorrhoeae* (Gonorrhea can cause pelvic inflammatory disease which can result in ectopic pregnancy, infertility, and chronic pelvic pain.) (Treponema pallidum is the Syphilis bacteria) (Condyloma acuminatum is genital warts)

Which patient will the nurse plan on teaching about the Gardasil vaccine? a.) A 24 year old patient who has not been sexually active b.) A 34 year old woman who has multiple sexual partners c.) A 19 year old woman who is pregnant for the first time d.) A 29 year old woman who is in a monogamous relationship

a.) A 24 year old woman who has not been sexually active (Gardasil vaccine is for HPV intended for women age 9-26 who are not pregnant, preferably before first sexual encounter, and now for men of the same age group, but controversial for men)

A patient complains of painful urination. A physical exam reveals vesicles on her labia, vagina, and foreskin of her clitoris. The nurse will expect to teach the patient about which medication? a.) Acyclovir (Zovirax) b.) Azithromycin (Zithromax) c.) Metronidazole (Flagyl) d.) Tinidazole (Tindamax)

a.) Acyclovir (Zovirax) (Symptoms are consistent with genital Herpes *virus*. Treatment does not cure, only treat)

During a routine drug screening, an asymptomatic, pregnant patient at 37 weeks gestation learns that she has an infection caused by Chlamydia trachomatis. The nurse will expect the provider to order which drug? a.) Azithromycin b.) Doxycycline c.) Erythromycin ethylsuccinate d.) Sulfisoxazole

a.) Azithromycin (preferred for pregnancy)

An adolescent patient comes to the clinic complaining of a burning sensation upon urination and a pus-like discharge from the penis. The nurse is correct to suspect that the patient has which disorder? a.) Gonorrhea b.) Herpes simplex c.) Nongonococcal urethritis d.) Syphilis

a.) Gonorrhea (this is the clinical manifestation for men)

A 39 year old patient with a history of IV drug use is seen at a community clinic. The patient reports difficulty walking stating, "I don't know where my feet are." Diagnostic screening reveals positive Venereal Disease Research Laboratory (VDRL) and flourescent treponemal antibody absorption (FAT-abs) tests. Based on the patient history, what will the nurse assess (select all that apply? a.) Heart sounds b.) Genitalia for lesions c.) Joints for swelling and inflammation d.) Mental state for judgement and orientation e.) Skin and mucus membranes for gummas

a.) Heart sounds d.) Mental state for judgement and orientation e.) Skin and mucus membranes for gummas (pictured) *key: symptoms of tertiary (late) syphilis*

A 20 year old woman who is being seen in the family medicine clinic for an annual physical exam reports being sexually active. The nurse will plan to teach the patient about: a.) Testing for Chlamydia infection b.) Immunization for herpes simplex c.) Infertility associated with the human papillomavirus (HPV) d.) The relationship between the herpes virus and cervical cancer

a.) Testing for Chlamydia infection

A 32 year old woman who is diagnosed with Chlamydia tells the nurse that she is very angry because her husband is her only sexual partner. Which response should the nurse make first? a.) "You may need professional counseling to help resolve your anger." b.) "It is understandable that you are angry with your husband right now." c.) "Your feelings are justified and you should share them with your husband." d.) "It is important that both you and your husband be treated for the infection.

b.) "It is understandable that you are angry with your husband right now." (It's best to validate and encourage discussion first. Deal with anger first, then start treatment)

A nurse in the outpatient clinic notes that the following patients have not received the Human Papillomavirus (HPV) Vaccine. Which patients should the nurse plan to teach about the benefits of this vaccine (select all that apply)? a.) 24 y-o man with a history of genital warts b.) 18 y-o man who has one male sexual partner c.) 28 y-o woman who has never been sexually active d.) 20 y-o woman who has a newly diagnosed Chlamydia infection e.) 30 y-o woman whose sexual partner has a history of genital warts

b.) 18 y-o man who has one male sexual partner CHECK BOOK- ANSWER NOT DONE (Vaccine intended for patients age 9-26, and even for those already infected) d.) 20 y-o woman who has a newly diagnosed Chlamydia infection Gardasil vaccine recommended before onset of sexual activity (& before age 26) and possible exposure to HPV.

When assessing the female client who is suspected of having primary syphilis, the nurse should expect the client to exhibit the early sign of: a.) Flat wart-like plaques around the anus and vagina b.) An indurated painless nodule on the vulva that begins to drain c.) Glistening patches in the mouth covered in yellow exudate d.) A maculopapular rash on the palms of the hands and soles of the feet

b.) An indurated, painless nodule on the vulva that begins to drain

A 22 year old patient with gonorrhea is being treated with a single IM dose of ceftriaxone (Rocephin) and is given a prescription for doxycycline (Vibramycin) 100mg bid for 7 days. The nurse explains to the patient that this combination of antibiotics is prescribed to: a.) Prevent reinfection during treatment b.) Treat any coexisting chlamydial infection c.) Eradicate resistant strains of N. gonorrhoeae d.) Prevent the development of resistant organisms

b.) Treat any coexisting chlamydial infection

A patient admitted with chest pain is also found to have positive Venereal Disease Research Laboratory (VDRL) and flourescent treponemal antibody absorption (FAT-abs), tests and rashes on the palms and soles of the feet, and moist papules in the anal and vulvar area. Which action will the nurse include in the plan of care: a.) Assess for arterial aneurysms b.) Wear gloves for patient contact c.) Place the patient in a private room d.) Apply antibiotic ointment to the perineum

b.) Wear gloves for patient contact

A 48 year old male patient who has been diagnosed with gonococcal urethritis says he had recent sexual contact with a woman but says she did not appear to have any disease. In responding to the patient, the nurse explains that: a.) Women do not develop gonorrheal infections, but can serve as carriers to spread the disease to males. b.) Women may not be aware they have gonorrhea because they often do not have symptoms of infection c.) Women develop subclinical cases of gonorrhea that do not cause tissue damage or clinical manifestations d.) When gonorrhea infections occur in women the disease affects only the ovaries & not the genital organs

b.) Women may not be aware they have gonorrhea because they often do not have symptoms of infection

The nurse gives a client an IM dose of penicillin G for primary syphilis. Which client statement indicates a need for further teaching? a.) "I will wait in the clinic for 30 min to be sure I don't have a reaction." b) "When I get home, I will call my partner to tell them about my diagnosis." c.) "If I have sex with someone, I don't have to worry about spreading the disease." d.) "I plan to return to see my primary care provider for follow-up in 6, 12, and 24 months."

c.) "If I have sex with someone, I don't have to worry about spreading the disease."

A 16 year old adolescent arrives at the clinic complaining of increased vaginal discharge, intermittent vaginal bleeding, excessive bleeding during her periods, and pain in her lower abdomen. She relates an active sexual history with multiple partners. Based on this information the nurse recognizes that the client probably has: a.) Herpes b.) Syphilis c.) Gonorrhea d.) Toxoplasmosis

c.) Gonorrhea (clinical manifestation for women)

A woman is diagnosed with primary syphilis during her 8th week of pregnancy. The nurse will plan to teach the patient about the a.) Likelihood of a stillbirth b.) Plans for cesarean section c.) Intramuscular injection of penicillin d.) Antibiotic eye drops for the newborn

c.) Intramuscular injection of penicillin

A patient is admitted to the hospital with headache, fever, malaise, joint pain and enlarged lymph nodes. Blood cultures are positive for Treponema pallidum. The nurse recognizes this as which type of syphilis? a.) Congenital b.) Primary c.) Secondary d.) Tertiary

c.) Secondary

A nurse is teaching a group of adolescent students about sexually transmitted diseases. Which statement by a student indicates understanding of infections caused by C. trachomatis? a.) "Chlamydia trachomatis conjunctivitis in newborns can result in blindness" b.) "The CDC recommends screening for Chlamydial infections in all sexually active men." c.) "Treatment for C. trachomatis should be initiated when infections are symptomatic" d.) "Women with asymptomatic Chlamydia trachomatis infections can become sterile"

d.) "Women with asymptomatic Chlamydia trachomatis infections can become sterile"

A client diagnosed as having syphilis tells the nurse that it must have been contracted from a toilet seat.The nurse knows this can't be true because the causative agent of syphilis is: a.) Immobilized by body contact b.) Chelated by wood and plastic c.) Destroyed by warmth and moisture d.) Inactivated when exposed to a dry environment

d.) Inactivated when exposed to a dry environment

Palpating uterus after delivery as opposed to boggy

should feel firm and well-contracted.